Review of An Imperative to Cure Principles and Practices of Q’eqchi’ Maya Medicine in Belize By James B. Waldram, Albuquerque: University of New Mexico Press. 2020. 271 pp.

Reviewed Book

An Imperative to Cure: Principles and Practices of Q’eqchi’ Maya Medicine in Belize By James B. Waldram, Albuquerque: University of New Mexico Press. 2020. 271 pp.

Ancient Maya figure sitting while holding a cup to its mouth
Cover of An Imperative to Cure (2020)

Miguel Cuj

Vanderbilt University

James B. Waldram’s captivating book, An Imperative to Cure, provides insight into cultural practices of health, Indigenous medicine, and meta-material inquiries nested in a Q’eqchi’ community—an indigenous group of Maya descent, residing in Belize, Central America. As a cultural anthropologist focused on medical issues Waldram is able to provide in-depth analysis of Indigenous knowledge and medical practices of Q’eqchi’ iloneleb’ (Q’eqchi’ medical practitioners). Because Q’qechi’ iloneleb’ have interrelated Indigenous knowledge behind health, sickness, and treatments, Waldram uses ontological and epistemological frameworks of analysis combined with a medical anthropological approach on what constitutes the “medicine”. Drawing upon ethnographic research conducted over 15 years, An Imperative to Cure artfully integrates ethnographic narratives, personal experiences, and therapeutic practices. Waldram shows how Q’eqchi’ iloneleb’ implement, practice, and promote Indigenous “medicine”. Waldram’s argument frames Indigenous people as practicing “medicine”. By highlighting Q’eqchi’ (Maya) language terms, cultural aspects, and social conditions of Q’eqchi’ population, Waldram has crafted a compelling book that has the potential to bridge our understandings of Indigenous medical practices and Western medicine within medical anthropology.

The book is structured into seven chapters that guide the reader through an engaging exploration of Q’eqchi’ medical practices, offering a rich ethnographic analysis. The opening chapters provide a broad overview of medical anthropology theories (its shades and contrasts) about medicine, Indigenous knowledge, and summarize research about Indigenous medicine in Mesoamerica. These opening chapters also describe Waldram’s methodological approach and data collection techniques.

As a Canadian-based anthropologist, – Waldram is aware of his positionality and recognizes his status as an external social scientist, centering his focus on research knowledge about Indigenous medicine derived from Q’eqchi’ iloneleb’. Waldram aims to approach his subject through self-reflexive participant observation, interviews, medical visits, pile sorts, and digital records (videos that Q’eqchi iloneleb’ record of their own medical practices and visits). Waldram turns to Q’eqchi’ iloneleb’ as the main ethnographic focus, and patients as secondary actors. To do it, Waldram located his site of study. Waldram discloses his research site, southern Toledo district of Belize, and reveals the names of six key informants (Q’eqchi’ iloneleb’). While Waldram states that he has approval from three different IRBs for the different stages of his research, his practice of explicitly naming the site and the key informants brings up questions about privacy and confidentiality in social research, even though the Q’eqchi’ iloneleb’ gave permission to reveal this information. Additionally, the patients play a relevant role given that Waldram recorded the Q’eqchi’ iloneleb’ medical practices performed in patients. Yet, the book does not make clear how Waldram ensured that all subjects gave their informed consent across the different stages of his 15 years of research. More explicit discussion of these practices is critical for future anthropologists who work with Indigenous populations.

Based on fieldwork conducted from 2004 to 2019, the book has the ambitious aim of synthesizing 15 years of research. This lengthy timespan has forced Waldram to determine which elements of the work to exclude and which to highlight. The book would have benefitted from a more explicit discussion of how these decisions were made. Waldram’s long-term approach questions the ethnographic field to inquire about research on Indigenous populations with regard to long-term records and methodologies.

Waldram’s rich ethnographic descriptions of Q’eqchi’ iloneleb’ practices are the heart of the book. The ethnography reveals the in-depth Indigenous knowledge and theory of medicine and the impact of this knowledge on sickness experiences within the Q’eqchi’ population. One of the primary contributions of this work, Waldram documents how Q’eqchi’ iloneleb’ organize and prioritize their dynamic medical knowledge as they treat sicknesses. This medical knowledge (nosology) is described by Waldram as contextual knowledge of particular sicknesses in the community of Toledo. This Indigenous medical knowledge allows Q’eqchi’ iloneleb’ to gain competence in these locally specific sicknesses in order to identify 7 types of disorders with Indigenous characteristics across psychological, emotional, mental, and spiritual states (107–108). The interaction of Indigenous (Q’eqchi’) medical knowledge with sickness (and not diseases or illnesses) is a key point that shapes cultural concepts of wellbeing and restoration within the local Indigenous population. These medical and health interactions represent a substantial contribution to exposing the indigenous medical knowledge of Q’eqchi iloneleb’ practices. Throughout the ethnography, Waldram also documents 116 Q’eqchi’ medical terms (Glossary, 231–235), which enriches Q’eqchi’ linguistic heritage in a pragmatic way for use and interpretation in Indigenous medical practice.

Diagnosis and treatment are two central aspects of the Q’eqchi’ medical process. The diagnostic process involves three interspersed assessments: narrative, signs and symptoms, and blood/player/pulse triads. The physical signs combined with aspects that lack physical form exhibit roots of animation cause sickness. Furthermore, the four pillars of Q’eqchi’ treatment involve: pulsation, prayer, pharmacology (native plants), and jilok (or massage). Diagnosis and treatment can require a material and metamaterial approach to properly treat sickness. For example, Q’eqchi’ iloneleb’ use spiritual and physical approaches for specific sicknesses. Q’eqchi’ iloneleb’ address sickness that stems from both physical and metaphysical aspects. In this sense, Waldram argues that metamaterial layers are part of Q’eqchi’ medical practice, which differs from the non-Indigenous (Western) medical approach.

From a syncretism perspective, the Q’eqchi’ iloneleb’ approach would be interpreted as a medical syncretism rather than a unique Q’eqchi’ practice as it follows some aspects of diagnosis and treatment Western knowledge, with spiritual aspects of the Catholic religion and Mayan spiritual issues. For example, the term Qaawa’ (God) used for the Q’eqchi’ Iloneleb’ (156-157) refers to the Christian trinity (father, son, and holy spirit) which overlaps with the four corners of the body in Q’eqchi’ interpretation. The use of Qaawa’ and Tzulltaqa’q (mountains and valleys) is also part of the syncretic approach. In this context, Waldram’s book could have a more in-depth analysis of the syncretic aspects of sickness, health, and wellness among Q’eqchi’ Iloneleb’. The analysis of medical syncretism in Q’eqchi’ iloneleb’ practices could be another angle to interpret and trace the holistic Q’eqchi’ medical system. An Imperative to Cure also explores how Q’eqchi’ medical concepts, including diagnosis and treatment, are understood and interpreted in the local Indigenous context, revealing complexities and perspectives that challenge simplified views from Western medical approach.

An Imperative to Cure will appeal to scholars in Mesoamerican studies, global health, medical anthropology, anthropology of healing, and Indigenous studies, especially those who focus on Indigenous medical systems. While more suitable for advanced undergraduates and graduate students, Waldram’s book offers insights into the transference and adaptation of Indigenous medical systems and biomedical discourse in the Global South. Waldrams’ book sheds light on the (often) hidden reality of Q’eqchi iloneleb’ lives and the impact on the medical system, making a significant contribution to scholarship on Indigenous knowledge. It is an engaging read for various subfields within medical anthropology, encompassing topics such as sickness experience, cultural studies, ethnographic methods, and health.